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The relationship between labour and social policy is at the heart of the social question. Scholars often treat this link as either a causal relation out there or a conceptual connection in policy makers' minds. This article examines its sociotechnical materiality instead. It follows anthropologists who ask how bureaucrats practice policy and scholars of science and technology studies who explore how social and technical aspects are interrelated in knowledge processes. China studies has suggested that the minimum livelihood guarantee (dibao) was originally designed as a market-oriented response to transformations of labour such as mass layoffs, peasant proletarianisation and associated unrest but later revamped to only combat extreme poverty. Ethnographic insights into dibao policy in a village in Sichuan show how its designed links to labour were erased and transformed through different methods of bureaucratic targeting, as well as expectations about the bureaucratic ability to know. For a time, dibao was even integrated into alternative rural development projects aimed at decommodification. Studying social policy as a knowledge process uncovers how its sociotechnical links to labour reconfigure it as an answer to the social question. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the early development and nurturing care environment of children aged 0–6 years in rural China and to evaluate the sex‐ and age‐specific associations of nurturing care environment with child developmental outcomes. Methods: A cross‐sectional survey involving 2078 children aged 0–6 years was conducted using a stratified cluster sampling strategy. We used face‐to‐face interviews to collect information on child, family and nurturing care. The Ages & Stages Questionnaires‐Chinese version and ASQ: Social‐Emotional were applied to assess children's neuro‐ and social–emotional development, respectively. Lower neurodevelopmental scores indicate an increased risk for neurodevelopmental delay, and higher social–emotional scores are indicative to a risk of social–emotional problems. The multiple linear regression model examined the associations of nurturing care environments with childhood development. Results: Among the investigated children, the average age was (42.9 ± 19.8) months and 55.8% were boys; 67.9% of the children had absent fathers because of labour migration and 54.0% had limited access to books and toys. Overall, boys had a lower total neurodevelopmental score than girls; similar gender patterns were also found in the domains of communication, fine motor, problem‐solving and person‐social. Concurrent absent fathers and limited access to books and toys were significantly associated with reduced neurodevelopmental scores [β − 11.44, 95% CI (−18.20, −4.68)] and increased social–emotional developmental scores [β 5.88, 95%CI (1.35, 10.41)] after controlling for confounding factors. Sex‐specific analysis only echoed the results in boys. Additionally, having an absent father and limited access to books and toys was associated with lower neurodevelopmental scores [β − 14.58, 95%CI (−25.41, −3.75)] in children under 3 years of age and higher social–emotional developmental scores among children aged 3–6 years [β 10.66, 95%CI (5.09, 16.24)]. Conclusions: Children, especially boys, with absent fathers due to labour migration have poorer neuro‐ and social–emotional development. Limited access to books and toys and father absence are linked to the children's developmental delay, especially for those under 3 years of age. Our findings suggest that intervention programs in resource‐constrained rural areas are desirable; more importantly, such programs should begin before 3 years of age to achieve a benefit–cost outcome. [ABSTRACT FROM AUTHOR]

Household income predicts early adolescents' cognitive development. However, the mechanism underlying this association and protective factors are unclear. This study assessed one-year longitudinal data to examine whether perceived discrimination mediated the association between household income and executive function and the moderating role of shift-and-persist. 344 early adolescents in rural China were included in the study (mean = 10.88 years, SD = 1.32 years, girls: 51.74%). The latent variable model revealed that household income predicted early adolescents' cognitive flexibility and working memory in the subsequent year through perceived discrimination. Shift-and-persist moderated the negative effects of perceived discrimination on cognitive flexibility: perceived discrimination impeded cognitive flexibility only among early adolescents with low shift-and-persist. The findings highlight perceived discrimination in the relation between household income and early adolescents' executive function and underscore the protective role of shift-and-persist. [ABSTRACT FROM AUTHOR]

Living arrangements and health behaviors are considered to be associated with mental health, but their relationship has been less investigated by national survey data in China. The purpose of this study is to explore the relationship of living arrangements and health behaviors with anxiety among Chinese older people and to compare the results between urban and rural areas. The study was based on the Chinese Longitudinal Healthy Longevity Survey conducted in 2018, and a total of 12 726 old-aged respondents were included. Ordinal logistic regression was used to analyze the associations between living arrangements, health behaviors and anxiety. This study found that people living in nursing institutions are likely to be more anxious than their dwelling counterparts. Although we found no significant relationships of health behaviors such as smoking, drinking alcohol and exercise with anxiety, older adults with greater dietary diversity were less likely to experience anxiety. Furthermore, different trends between living arrangements and anxiety, smoking and anxiety were also found among urban versus rural respondents. The findings of this study help to better understand anxiety among Chinese older people and shed light on health policy on older people protection and services. [ABSTRACT FROM AUTHOR]

Background: Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. Aims: This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. Methods: A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. Results: Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. Conclusions: The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services. [ABSTRACT FROM AUTHOR]

A significant number of students in rural China drop out of junior high school. However, current analysis of the similarities and differences among these students are inadequate. Thus, we sought to explore the typology of students who dropped out of junior high school in the rural Hainan Province of China. We used latent class analysis to identify five types of students who chose to drop out. The categories included unexpected, unsupportive, maladjusted, financial difficulties, and peer-negative. Employing this typological classification as a guide, we explore the implications of our findings for future efforts in the field of research and in the prevention of junior high school withdrawal. Highlights: We explored the typology of students who dropped out of junior high school in the rural Hainan Province of China. We classified the dropout types as unexpected, unsupportive, maladjusted, financial difficulties, and peer-negative. Assessing and understanding a students' decision to drop out can facilitate future intervention efforts. [ABSTRACT FROM AUTHOR]

The decision of whether to grow old in one's home (also referred to as ageing in place (AIP)) or relocating to an institution is an ongoing negotiation process, which involves residential decisions and adaptation. This research aims to explore how childless older adults in rural China choose between AIP and institutionalisation. Through a qualitative study conducted in rural China among childless older adults, we explored the reasons why they make certain residential choices and how they adapted during the decision process. Twenty-five childless participants (aged 60–83) were interviewed. Findings suggested that they referred to the term ku (literally meaning 'bitterness'; and a metaphor referring to 'conducting farming and farm-related activities') to explain their residential decisions. If a person could endure ku – sustain food and basic living through farming and farm-related activities, they tended to choose to age in place; otherwise, they chose to relocate to institutions. Ku represents a sense of mastery, encompassing the stressfulness and suffering aspect that requires adaptation. Three adaptive strategies were identified: (a) positive reappraising of the negative aspect of ku , (b) routinising ku , and (c) transcending the narrative of ku into a toughness identity. Our findings suggest that childless older adults struggled to achieve residential mastery while making residential decisions, even though a sense of mastery was shaped by the individual and structural constrictions. [ABSTRACT FROM AUTHOR]

(1) Background: Low-income rural residents in China are disadvantaged due to their financial vulnerability and insufficient access to resources, and this situation demands more research effort. This study examined the pattern of outpatient service satisfaction and its determinants among low-income adults in rural China. (2) Methods: Rural low-income respondents who used outpatient services in their local healthcare facilities in Jiangsu, China evaluated the access, cost, environment, doctor–patient interaction, and other topics during their outpatient visit (N = 662). Latent class analysis was used to identify the groups characterized by various dimensions of outpatient satisfaction. Multinomial logistic regression explored the determinants of class membership. (3) Results: Three latent classes were identified: 28.70% had low satisfaction, unsatisfied with every dimension; 20.69% reported medium satisfaction that valued doctor–patient relationships; and 50.60% had high satisfaction but thought that costs were high. Both low and medium satisfaction were associated with a higher proportion of self-paid fees. (4) Conclusions: Healthcare costs were an important determinant of outpatient service satisfaction. Medical social workers are suggested to be included in the medical team to help patients identify financial assistance. Special aid programs may be developed to help relieve rural low-income patients' medical cost-related burden. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether and how poverty influences the long-term outcome of persons with severe mental illness (SMI). Aims: To explore the change of poverty status in persons with SMI from 1994 to 2015 and examine the impact of poverty status on patients' outcome in rural China. Method: Two mental health surveys using identical methods and International Classification of Disease (ICD-10) were conducted in 1994 and 2015 in the same six townships of Xinjin County, Chengdu, China. Results: The annual net income per person was 19.8% and 100.2% higher for the general population than for persons with SMI in 1994 and 2015 respectively. Compared with 1994 (48.2%), persons with SMI in 2015 had significantly higher rates of poor family economic status (

Reminiscing contributes to the formulation of identity in later adulthood through integrating individuals' recomposed past, perceived present and envisioned future. Aiming to understand rural Chinese elders' identity construction through reminiscing, we conducted semi-structured interviews with 20 elders living in ShiGo, a village located in the south-west of China. Data analysis suggests the rural elders in this study constructed a hero–victim identity through telling stories about the hardships they went through and the sacrifices they made. The participants narrated suffering from lack of basic living needs in the past, in particular before the 1980s while they were involved in turmoil brought on by wars and national movements, from destructive relationships, from making sacrifices for the country and their families, and from adapting to challenges brought on by the hardships. The rural elders shared life experiences with other villagers in daily life through bitter-sweet telling and wanted their suffering and sacrifices to be witnessed. Witnessing connects suffering, sacrifice, hero and victim into a self-enforcing system that helps the elders maintain interdependence and defence against existential concerns like death anxiety. A hero–victim dialectic model was presented to capture the self-enforcing attribute of the hero–victim identity. Findings of this study could be used to make sense of rural ageing in China and benefit clinical professionals working with rural Chinese elders. [ABSTRACT FROM AUTHOR]

Background: Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. Methods: Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. Results: For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from − 0.0636 (95 % CL: −0.0846, − 0.0430) before the policy to − 0.0457 (95 % CL: −0.0684, − 0.0229) after it. In addition, the horizontal inequity index decreased from − 0.0284 before the implementation of the policy to − 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from − 0.0532 (95 % CL: −0.0868, − 0.0196) before the policy was implemented to − 0.1105 (95 % CL: −0.1333, − 0.0876) afterwards; the horizontal inequity index of IHSU increased from − 0.0066 before policy implementation to − 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. Conclusions: The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy's original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage. [ABSTRACT FROM AUTHOR]

Rural middle school students often experience significant educational disparities compared to their urban peers, particularly in developing computer skills and computer and information literacy (CIL). However, there has been insufficient research on the impact of poverty stigma on their CIL development. To address this literature gap, this research examines the influence of poverty stigma and self-efficacy on CIL performance among rural eighth graders in two studies. Guided by the social cognitive theory and labeling theory, Study 1 (n1 = 2,783) analyzes the mediating effects of family socioeconomic status and self-efficacy on CIL, while Study 2 (n2 = 2,153) investigates the mediating effects of perceived poverty stigma at the dimensions of social stigma and self-stigma on CIL. The results suggest that poverty, family socioeconomic status, and computer use at school positively affect CIL, with self-efficacy mediating the relationship between them. While students from low-resourced families do not perceive social stigma as directly impacting their CIL, self-stigma plays a mediating role between perceived social stigma and CIL. These findings have significant implications for educators seeking to improve CIL in the digital age, emphasizing the importance of increasing computer access at school for better educational outcomes. • Rural students' computer literacy is hindered by relative poverty and self-stigma. • Poverty stigma directly affects students' computer and information literacy. • Self-stigma mediates the ties between social stigma and computer and information literacy. • This study calls for addressing stigma in fostering computer and information literacy. [ABSTRACT FROM AUTHOR]

Background: Older adults are more prone to various diseases. Health insurance becomes effective mechanism to relieve financial burden when the insured is sick. In China, most older adults live in the countryside, and New Rural Cooperative Medical Scheme is a kind of health insurance system in rural areas. The relationship between New Rural Cooperative Medical Scheme and financial burden due to health expenditure of older adults in China was investigated. This paper aims at the impact of New Rural Cooperative Medical Scheme on the poverty among rural older adults. Methods: This study employs Probit model and Tobit model to assess the impact of New Rural Cooperative Medical Scheme on alleviating poverty among rural older adults based on a survey in nine representative counties in western China. Results: The findings show that diseases have significantly negative impact on rural elderly poverty. New Rural Cooperative Medical Scheme has impact on alleviating of the health-payment poverty due to catastrophic health expenditure, but the impact is limited. The impact of health insurance on poverty alleviation is greater for men, older adults aged between 60 to 69 and households in in economically poorer area than their counterparts. Conclusions: This study show the relationship between New Rural Cooperative Medical Scheme and catastrophic health expenditure of older adults in China. The results draw policy attention to introduce different reimbursement expense ratios for different groups to alleviate them from poverty based on more comprehensive insurance packages. [ABSTRACT FROM AUTHOR]

Objective. The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. Methods. Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6∼12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. Results. The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. Conclusions. The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the effects of the maternal and child health (MCH) system strengthening through multilevel governmental collaboration in Nujiang Prefecture, China. A case study design was applied. Guided by the logical framework of the Nujiang MCH Comprehensive Intervention Project, national, provincial, and prefecture government sectors jointly implemented comprehensive health system strengthening (HSS) interventions in Nujiang Prefecture. In this case study, we conducted the end point surveys (November 2015 and January 2016) with 33 local MCH facilities. We also interviewed 35 MCH providers, government officials, leaders of MCH facilities, and project specialists. The thematic framework method was used to analyze the interview data, and descriptive analysis was performed to analyze the survey data. The three levels of governmental collaboration contributed to increased government investment in the local MCH system and ensured the successful implementation of the project. Participatory training methods and appropriate HSS interventions tailored to the local context were crucial to improve MCH providers' knowledge and skills, with the proportion of qualified MCH providers increasing from 70% in 2011 to 96% in 2015. Owing to this increase in knowledge and the increase in needed equipment, more MCH hospitals could provide inpatient obstetric services, and more town health clinics were capable of providing basic MCH services. The development of a reimbursement policy tailored to the local context promoted in-hospital delivery. At the conclusion of the project, percentages of antenatal care, in-hospital delivery, and newborn screening increased by 20.71%, 18.12%, and 278.62%, respectively. Growth monitoring coverage for children younger than three years remained stable at around 90%. However, the MCH system was negatively impacted by the workforce shortage. Those shortages were caused by a lack of positive recruitment and retention and incentive policies. Implementation of comprehensive HSS interventions through multilevel governmental collaboration improves the MCH system in remote and low-income areas. • Multilevel governmental collaboration improves the Maternal and Child Health (MCH) system in remote and low-income areas. • Participatory training methods contributes to the positive effects of health system strengthening interventions. • The MCH system is negatively impacted by the workforce shortages and inadequate incentives for health providers. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we explored the association between sleep quality, duration and prevalence of rheumatoid arthritis (RA) among low-income adults in rural areas of China. Methods: Face-to-face investigation were conducted in 2017, and completed questionnaires were obtained from 16,648 individuals. Sleep quality and duration were evaluated using the standard Pittsburgh Sleep Quality Index. RA was based on self-reported physician diagnosis. Logistic regression analysis and restricted cubic spline models were performed. Results: Sleep duration shorter than 7 hours was associated with increased odds of RA, with an odds ratio (OR) of 1.49 for 6–<7 hours and 1.70 for <6 hours. Poor sleep quality was associated with RA, with an OR of 1.68. The combination category of poor sleep quality and any group of sleep duration was associated with a significantly increased risk of developing RA. Combined groups of good sleep quality with short sleep duration (<7 hours) were also found to be related to prevalence of RA. There was a non-linear relationship between sleep quality, duration and the odds of RA. Conclusions: Poor sleep quality and short sleep duration may be trigger or risk factors for RA. [ABSTRACT FROM AUTHOR]

Background. In China, there are currently 584 state-level, poverty-stricken counties with an average income <400 yuan ($57) a year. The central government has invested a large amount of funds and preferential policies to alleviate poverty in these areas. The Whole Population Preventive Healthcare Pilot Project (WPPHCPP) aims to explore the use of limited funds to achieve healthy poverty alleviation through free regular physical examinations and comprehensive health management for the entire population in impoverished regions. Objective. By demonstrating the prevalence of hypertension in populations of poverty-stricken counties in Western China and evaluating health management outcomes after implementing the WPPHCPP, we can provide a foundation for the future development and promotion of improved public health. Subjects and Methods. Through the WPPHCPP, the entire population in the pilot area was required to undergo free physical examinations. The examinations screened for hypertension revealed the epidemiology of adult hypertension. Based on blood pressure levels and risk factor exposures, risk classifications for hypertensive patients were performed. Corresponding intervention and management strategies for different risk levels were provided by a joint management team consisting of family physicians from three different levels of local medical institutions (village, town, and county). Healthcare management outcomes including awareness, treatment, and hypertension disease rates were compared between the period before and after the intervention and management. Results. By the end of 2017, among the 452,200 permanent residents in the region, 285,458 adults had completed the physical examination. The prevalence of hypertension was 18.5%, which was lower than the national average of rural areas (28.8%). The prevalence of hypertension in men (18.7%) was slightly higher than that of women (18.3%). The prevalence of hypertension increases with age; for people aged >65 years, it was 39.2%. There were 15,074 newly discovered hypertensive patients in the WPPHCPP, accounting for 29.6% of the total hypertensive population in the region. Regarding the management outcomes, the rates of management and standardized management of hypertension increased each year between 2015 and 2017. Although the rate of disease control management decreased slightly, the overall level of management remained significant. The awareness and treatment rates of hypertension also increased over the years and peaked at 95.0% and 94.9%, respectively, in 2017. The disease control rate was 45.6% in 2016, which was the highest among the years assessed. All the above parameters were better than the national average of rural areas. From 2015 to 2017, the number of people with high-risk factors for hypertension and percentage of high-risk patients decreased from 33,064 to 26,982 and 27.4% to 24.6%, respectively. The percentage of the population exposed to cigarettes and alcohol decreased from 30.6% to 27.2% and 25.1% to 22.0%, respectively. The number of deaths due to hypertensive cardiovascular or cerebrovascular diseases decreased each year and was 275 (39.55/100,000 people) in 2017, which was the lowest rate measured. The annual growth of cardiovascular or cerebrovascular diseases remained negative. Conclusions. The overall prevalence of hypertension in the studied area was lower than the national average of rural areas. The health management model of "government-led joint efforts of three levels of medical institutions (village, town, and county) with active participation of local village communities" improved the management outcomes of hypertensive patients and fulfilled the latest advocacy of the prevention and control of chronic diseases by the United Nations. This model can be considered an effective model for healthcare management practice in similar situations. [ABSTRACT FROM AUTHOR]

There is a large body of literature asserting that household asset holdings play a critical role in prospects of economic and social well-being. This study examines asset-poverty rates in China using the 2013 survey data from the Chinese Household Income Project (CHIP). The results indicate that asset-poverty rates in urban China were lower than those of developed countries, whereas rural and migrant households experienced more serious asset poverty than their counterparts in urban China. In addition, the asset-poverty rates were at least twice the income-poverty rates in China according to the different poverty lines used in the study. Several demographic characteristics were found associated with asset poverty. To assist the Chinese government in reaching its goal of eradicating absolute poverty by 2020 through targeted poverty alleviation, this study suggests including assets in the description and alleviation of poverty. [ABSTRACT FROM AUTHOR]

Poverty and poverty reduction in mainland China are the main concerns of development discourse and policy. Among poor individuals, children are the most vulnerable. This study aimed to investigate how multidimensional child poverty influenced children's academic achievement in poor rural areas in China. This study examined how this effect might be mediated by the stock of social relationships. Data were obtained from a questionnaire survey of 775 children (grades 4 to 9) living in the most underdeveloped rural areas in southwest China (Eryuan County). Results showed that multidimensional child poverty was negatively related to children's academic achievement. Social relationships played a significant role in mediating the effects of multidimensional child poverty on children's academic achievement. These findings provided valuable insights into the multidimensions of poverty and the underlying mechanisms from poverty to children's academic achievement. Implications in theory, social work practice, and social policy were discussed. Social work intervention and prevention were also developed in terms of fostering the growth of social relationships. • Poverty and poverty reduction in mainland China are currently the central concerns of development discourse and policy. • Multidimensional child poverty was negatively related to children's academic achievement. • Social relationships significantly mediated the effects of multidimensional child poverty on children's academic achievement. [ABSTRACT FROM AUTHOR]

This study analyzed child income poverty in China from 2005 to 2015 using data obtained from the Chinese General Social Survey. Building on the Foster–Greer–Thorbecke (FGT) methodology, this study estimated the headcount, poverty gap and poverty severity indexes of all children and the poverty gap of poor children. Subgroup decomposition, growth-redistribution decomposition of poverty changes and pro-poor growth measurements were conducted. The results show that the overall poverty level among children was high despite a decreasing trend, and poor children's relative economic status worsened, especially in rural areas; there were large disparities among different groups of children by urban/rural status, ethnicity and hukou. Rural children contributed more to the overall poverty level and poverty changes than urban children. The growth among children is not relatively pro-poor but only absolutely pro-poor, increasing the inequality and finally offsetting the effect of growth on reducing poverty to some extent. • Measuring and performing sub-group and growth-redistribution decomposition of child income poverty throughout China. • There are still a large number of children living in poverty in China despite a decreasing trend. • Growth among children in China is absolutely pro-poor but not relatively pro-poor. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prevalence of mild cognitive impairment (MCI) within the empty‐nest older adults population in poor rural areas of the Hunan province of China, and to explore the effects of resilience and affective balance on cognitive functioning within this specific population. Methods: A cross‐sectional, multistage, random cluster survey was administered to participants from March 2013 to December 2014 in the Hunan province. There were a total of 1164 participants. These participants were empty‐nest older adults who were residing in poor rural areas of the Hunan province. The data was collected in two stages. In stage 1, the participants were administered the Montreal Cognitive Assessment for screening cognitive impairment. In stage 2, the participants were screened for any potential cognitive impairment, were administered a series of neuropsychological tests and received a definitive diagnosis for MCI, if the criteria were met. Resilience and affect balance were assessed by the Chinese modified version of the Stress Resilience Quotient and the Affect Balance Scale. Results: The prevalence of MCI was 38.40% within this empty‐nest older adult population. Significant differences were found between MCI and non‐MCI empty‐nest older adults specific to resilience and affect balance. Path analysis showed that resilience mediated the relationship between MCI and affect balance. Conclusions: Resilience and affect balance were less prominent within the MCI empty‐nest older adults than those in the non‐MCI group. The results suggest that resilience is a mediating variable between MCI and affect balance. Geriatr Gerontol Int 2019; 19: 222–227. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural China. Study design A quasi-experimental design was applied, with data collection before and after a 2-year programme implementation, in both intervention and comparison (control) areas. Methods From July 2014, the Integrated Early Childhood Development (IECD) programme was implemented in poverty-stricken areas in four counties of China. Nurturing care intervention focusing on five components (child health, nutrition, responsive care, protection and early learning support) was delivered mainly by the village early childhood development centre and township/village clinic. Another two counties of similar per capita gross domestic product, geographical characteristics, under-five mortality rate, under-five underweight prevalence and ethnicity to the four programme counties were selected as the comparison and received no IECD programme intervention. The Ages & Stages Questionnaire was used to evaluate the neurodevelopmental outcome of children; the overall suspected developmental delay (SDD) referred to any developmental delay in the communication, gross-motor, fine-motor or problem-solving or personal-social domains of the questionnaire. Children underwent anthropometric measurements and haemoglobin concentration testing through peripheral blood. Face-to-face interviews of caregivers were conducted to collect intervention use, cognitive stimulation and child-protection behaviours. A difference-in-differences regression approach, adjusting for confounding factors, was applied to estimate intervention impact on the neurodevelopmental outcomes in the children. Path analysis was employed to examine the mediating effects of growth, nutrition status, cognitive stimulation and child-protection behaviours through which the IECD intervention predicted children's developmental health. Results In total, 2953 children aged under 3 years and their caregivers were enrolled at baseline, and 2745 child-caregiver pairs completed the postintervention assessment. Prevalence of overall SDD was reduced by 18% (from 37% at baseline to 19% at postintervention) in intervention counties, which is a significant difference compared with the 10% reduction in control counties (from 30% to 20%), with an adjusted odds ratio of 0.69 (95% confidence interval: 0.54–0.89). Consistent findings were found across domains. Path analysis indicated that the effect of the intervention on promoting developmental health was mediated by multiple nurturing care-associated factors, including cognitive stimulation frequency, positive discipline, length-for-age growth and haemoglobin concentration. Conclusions The community-based integrated intervention could significantly prevent developmental delay in children aged under 3 years in rural China. Highlights • A community-based, integrated and nurturing care-supporting intervention was established in rural areas. • Intervention reduced the prevalence of developmental delay in disadvantaged children. • Family processes mediated the link between intervention and early development. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence and related factors of cognitive impairment in community-dwelling older residents in Beijing, China.Methods: This is a cross-sectional study. A total of 2017 older individuals aged ≥ 60 years from Beijing Longitudinal Study of Aging were included in this study. Information on demographic characteristics, life style, chronic disease and geriatric syndromes was collected. Cognitive function was assessed by Mini-Mental State Examination.Results: The prevalence of cognitive impairment was 13.6% in community-dwelling older residents in Beijing. The prevalence of cognitive impairment was higher in women than it was in men and in rural areas than it was in urban areas, and increased with age. Logistic regression showed that older age [odds ratio (OR) = 1.496-3.033, P < 0.001], illiteracy (OR = 1.200-2.434, P = 0.003), low income (OR = 1.268-3.906, P = 0.005), less social participation (OR = 1.011-2.147, P = 0.044), stroke (OR = 1.410-3.305, P < 0.001), hearing loss (OR = 1.231-2.295, P = 0.001), depression (OR = 1.115-2.385, P = 0.012) and disability (OR = 2.315-4.681, P < 0.001) were independent risk factors for cognitive impairment.Conclusions: The prevalence of cognitive impairment among the older adults in Beijing was high. More attention should be paid to the identification of and intervention for factors influencing cognitive impairment, and health education should be carried out to improve the quality of life of the older adults. [ABSTRACT FROM AUTHOR]

Poly-victimization of children attracts increasing concerns in China, and a rapid growing number of cases on poly-victimization among left-behind children were reported. This study aims to test the association and mediating mechanism between poverty and poly-victimization of left-behind children in rural China. Representative survey data on left-behind children in rural China was analyzed in this study. Frequency and percentage were reported in descriptive analyses; Logistic Regression and mediating effects analysis were employed to test the association and detailed pathways between poverty and poly-victimization. About 27.50% of left-behind children suffered from at least one kind of victimization, and >10% suffered from poly-victimization (at least two kinds of victimization in the present study). Regression results revealed that poverty was significantly and consistently associated with poly-victimization when controlling for covariates. Furthermore, the mediating mechanism analysis showed that, in the association between poverty and poly-victimization, it is the increased vulnerability from individual (individual psychological and behavioral health) and family (quality of family care) rather than vulnerability from surrounding interactions, plays a significant mediating role. This study stresses the importance of poverty alleviation in policy making for the protection of left-behind children from victimization in China. Also, support from family and school in protecting left-behind children should be paid additional attention. [ABSTRACT FROM AUTHOR]

Background: Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Methods: Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. Results: The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Conclusion: Our study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits. [ABSTRACT FROM AUTHOR]

Aim This study aims to investigate the medical expenditure of people with Type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households. Methods A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care. Results In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times ( US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group. Conclusion Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles within the issue on topics including how individual empowerment and resilience influence community resilience; reduction in rural poverty in China between 1986 and 2010; and entrepreneurship for community practitioners.

Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. [ABSTRACT FROM AUTHOR]

Aims To estimate the prevalence, awareness, treatment and control of diabetes in rural areas in Shandong Province, China. Methods The Luxemburg- WHO-Shandong Project on Rural Health Personnel Training and Chronic Disease Control, a cross-sectional study, examined 16 375 rural residents aged 25 years and over using multistage cluster sampling in April 2007. An overnight fasting blood specimen was collected to measure plasma glucose and a 2-h 75-g oral glucose tolerance test was conducted among people with a fasting blood glucose of ≥ 6.1 mmol/l. Information on the history of diabetes and hypoglycaemic medication was obtained using a standard questionnaire. Diabetes and prediabetes were defined according to the 1999 World Health Organization diagnostic criteria. Results Overall, the prevalence rates for diabetes, prediabetes and previously diagnosed diabetes in the rural population were estimated to be 3.5%, 6.0% and 1.2%, respectively. Among those with diabetes, only 34.8% were aware of their condition, 30.6% were currently undergoing medication treatment, and 11.5% achieved glycaemic control. Conclusions These results indicate that diabetes has become a public health problem in poor rural areas of China and the rates of awareness, treatment and control of diabetes were relatively low. There is an urgent need for strategies aimed at the prevention and treatment of diabetes in the rural population in Shandong Province, China. [ABSTRACT FROM AUTHOR]

• Older adults' unmet long-term care needs in china and taiwan were compared. • Care poverty concept/Andersen's behavior model were employed for the comparison. • The care poverty rate in IADL was lower in taiwan than in china. • Unmet needs were driven by different factors between two groups of older adults. • LTC services should meet the IADL care needs in both china and taiwan. Applying the concept of care poverty and Andersen's Behavior Model, this study compares the patterns of unmet long-term care needs and investigates the association between unmet needs and the depression and life satisfaction of older adults aged ≥ 65 in China and Taiwan that belong to the same East Asia welfare model. Data come from the 2015 China Health and Retirement Longitudinal Survey (N = 6,341) and the 2015 Taiwan Longitudinal Study on Ageing (N = 4,588). Older adults in China and Taiwan differ significantly in terms of demographic and socioeconomic characteristics. The care poverty rate in activities of daily living (ADL) in these two Asian societies was similar and the rate in instrumental activities of daily living (IADL) was lower in Taiwan than in China. Regression analyses showed that unmet care needs were associated with different predisposing and enabling factors between older Chinese (e.g., residential area and marital status) and Taiwanese (e.g., living arrangement and frequency of seeing children) adults, but the association between depressive symptoms and life satisfaction and unmet care needs were highly similar based on comparison of correlation coefficients. Chinese disadvantaged older adults facing a higher risk of unmet care needs were those who were single and lived in rural areas, while Taiwanese were those who lived alone and had no close relationship with children. Additionally, long-term care services should meet the IADL care needs but not be limited to only meeting ADL care needs in both China and Taiwan. [ABSTRACT FROM AUTHOR]

This paper analyses the multidimensional child poverty status and its dynamic changes in China from 1989 to 2009 using the China Health and Nutrition survey data. Built on the Alkire–Foster methodology, the adjusted child poverty headcount ratio is calculated which measures not only the traditional headcount ratio of child poverty but also the average deprivation intensity among poor children. The overall poverty rates declined over years from 1989 to 2009 in national wide and among provinces, where the key driver was the reduction of the poverty headcount ratio. With the property of decomposition for the adjusted headcount ratio, this study also examines the provincial and regional contribution to the national poverty reduction. Provinces in the middle region of China received the biggest reduction of child poverty rate, and the regional gap of child poverty has been narrowed down, but more effort of poverty reduction should be made to the poorest provinces and rural areas. [ABSTRACT FROM AUTHOR]

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6–14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number=4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6·1 % in the entire studied population and 16·3 % in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1·14 v. 0·96; P=0·043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3·08; 95 % CI 1·47, 6·46; P=0·003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community. [ABSTRACT FROM PUBLISHER]

With China’s gender imbalance and increasingly severe male marriage squeeze, patterns of intergenerational support in rural areas are likely to undergo significant change. Using data from a survey of four towns from X county in Anhui province carried out in 2008, this article analyzes the effects of sons’ marital status on intergenerational support. Random-effect regression analysis shows that son’s marital status has strong effects on financial support to and coresidence with parents. Compared with married sons, older unmarried sons (so-called forced bachelors) tend to provide less financial support to their parents and are more likely to live with their parents. Parents’ support of sons, as well as the parents’ own needs and sons’ capabilities all affect the support provided by sons. These results show that both theories of exchange and altruism are simultaneously relevant in the context of the marriage squeeze of contemporary rural China. [ABSTRACT FROM AUTHOR]

• Poverty exposure affects children's cognitive abilities in rural China. • We used a nationally representative sample. • We constructed an IV based on the heteroskedasticity of the error term of the poverty status. • IV estimates suggested that poverty significantly led to low cognitive abilities of children. • Oaxaca-Blinder decomposition results showed that family investments were quite important. Family poverty may affect family investments, which affect children's cognitive development. Based on a unique and nationally representative sample from the National Children's Study of China (NCSC), this study aimed to explore the relationship between poverty and children's cognitive abilities and the roles of different investments to the cognitive gaps. We had the following three findings. First, the cognitive abilities of children in poor families were significantly and negatively affected by their families' poverty status. Second, poverty was significantly correlated with lower family education expenditures, lower expectations of parents for their children's education, and more permissive parenting styles. Finally, the results of the Oaxaca-Blinder decomposition method showed that family educational expenditures, educational expectations, and permissive parenting styles accounted for substantial portions of the gaps in cognitive abilities. [ABSTRACT FROM AUTHOR]

• About 700 million people have been lifted out of poverty since 1978. Yet, there were still millions of poor people in China. • Chinese government announced a plan to eliminate poverty by 2020 and calls for enterprises in this effort. • This study uses the China Philanthropy platform, supported by the Bank of China, as a case study. • The results indicate that this novel platform improves work skills of the workers and their family income and expenditures. Since its economic reforms in 1978, China has seen nearly 700 million people lifted out of poverty. Although a great feat, millions of people, concentrated primarily in rural areas of the country, continue to experience extreme poverty. In order to address this issue, the Chinese government announced a strategy, called targeted poverty alleviation, to eliminate poverty by 2020. This strategy calls upon the cooperation of enterprises in this poverty alleviation effort. This study examines the China Philanthropy platform to illustrate how targeted poverty alleviation efforts have led to an innovative and successful e-commerce platform, which has shown positive effects on skills development, income, and resource allocation for workers and their families. The results indicate that this novel platform has strong potential to improve the professional skills of the participants and increase their family incomes. In turn, the families have more income to allocate to the education expenses of their children, an indicator of human capital accumulation. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

• Our study solves the endogenous problem with the PSM-DID model, identifies the causal effects of the program, and offers findings that can be used to broaden understanding of the impact of CT programs. • Our study enriches knowledge about Unconditional Cash Transfer (UCT) programs. • We discuss the possibility that teachers offer subsidies based on students' academic performance—and we offer insight into policy design, to more effectively improve educational outcomes among underprivileged children. Poverty has significant and lasting adverse impacts on child development. In recent decades, Cash transfer (CT) programs are widely used to address child poverty, and have become one of the most important social-protection programs for improving welfare outcomes of children. This study evaluates the effects of the rural-China School Subsidy Program (SSP) on compulsory student academic, cognitive achievement, and enrollment outcomes. Instituted in 2006, the program targets students from poor families in rural areas, who receive cash transfers of about 1000 yuan (US$150) per year, or 15% of the average per capita disposable rural income. Our sample is drawn from the China Education Panel Survey (CEPS), and includes 3552 compulsory students in rural China. In the data analysis, we employed the difference-in-differences model with propensity score matching (PSM-DID), and the logit model. Our results show that the program significantly increases student enrollment, but has no effect on academic performance or cognitive achievement. Further, the positive enrollment effects of the program are greater for students with less-educated fathers. The results are robust across alternative matching methods. Our findings suggest that the program results in partial improvement to student enrollment in rural areas, but that more support is needed for improving overall student welfare. One concern in implementing the SSP is that due to the lack of effective supervision, teachers are more likely to offer subsidies to students with high academic standing. This will reduce the welfare improvement effect of SSP. [ABSTRACT FROM AUTHOR]

Background: China poverty reduction policy (PRP) addresses two important elements: the targeted poverty reduction (TPA) project since 2015 in line with social assistance policy as national policy; and reducing inequality in health services utilization by making provision of medical financial assistance (MFA). Therefore, this study aims to assess the effects of the PRP in health services utilization (both inpatient and outpatient services) among the central and western rural poor of China. Methods: The study conducted household survey and applied propensity score matching (PSM) method to assess the effects of the PRP on health services utilization among the rural poor of Central and Western China. A sensitivity test was also performed on the PSM results to test their robustness. Results: Key findings showed 17.6% of respondents were the beneficial of PRP. The average treatment effects on the treated (ATT) of the PRP on the inpatient visits within one year was found significantly positive (P = 0.026). Conclusion: There has been relationship between PRP with medical financial assistance and reduction of inequality in health services utilization by the poorer, in particular to accessing the inpatient services from the county or township hospitals of China. Policy makers should pay attention for making provision of improving responsiveness of supply, when subsidizing on the demand side. [ABSTRACT FROM AUTHOR]

Background: Cancer is the second leading cause of death globally, causing a substantial economic burden on cancer suffers and their families. The aim of this study is to explore the prevalence, determinants and consequences of catastrophic health expenditure (CHE) among urban and rural end-of-life (EOF) cancer patients in China. Methods: Using respondent-driven sampling and face-to-face interviews, field research was conducted with a specialist questionnaire. Data were collected on 792 cancer patients who died between June 2013 and June 2016 in China. The determinants of household catastrophic expenditure were identified by multivariate logistic regression. Findings: It is found that more than 80% of cancer patients received life-extending treatment. Extremely high rates of CHE were identified among EOL cancer patients, at 94.3% for urban families and 96.1% for rural families. After spending for health, 84.1% of urban and 91.1% rural EOL cancer patient households were impoverished, falling below the poverty line. For both urban and rural households, income was the most significant factor associated with catastrophic health expenditure (CHE). Health insurance did not adequately compensate for CHE. Rural families experienced higher CHE, lower levels of health care utilization, a different mix of health care access and higher rates of borrowing for out-of-pocket (OOP) health care expenditures than urban families. Both urban and rural households suffered long-term economic disadvantage due to CHE and borrowing for OOP medical care expenses. Conclusions: EOL cancer patients experienced severe CHE, with families forced into poverty. With only about 1% of EOL cancer patients receiving palliative care, developing palliative care services and expanding the acceptance of palliative care in China is both urgent and essential. To help address impoverishment due to CHE, China should also develop targeted programs to reduce income inequality, especially rural-urban inequalities; increase access to health care; and accelerate health reform. Increasing the retirement age would provide households with more savings and wealth to withstand CHE. [ABSTRACT FROM AUTHOR]